Introduction

Most women experience postpartum depression (PPD), commonly known as “baby blue” after childbirth.¹ Baby blue starts within the first 2 to 3 days after delivery and usually lasts for a few weeks to months.¹ Postpartum depression is a mood disorder that presents as mood swings, anxiety, and difficulty sleeping. Within a year of giving birth, around one in ten women have this prevalent issue.² Fathers may also be impacted, as new studies have shown that fathers can experience PPD too; they may feel sad, tired, overwhelmed, anxious, and have problems with their eating and sleeping patterns, which are similar to the symptoms that women experience.³

Postpartum depression affects relationships, and it is common for couples to face marital problems for up to a year after childbirth. These issues typically result in lifestyle changes and make maintaining a happy, healthy relationship harder. Some studies have shown that PPD causes a woman to spend less time with her partner, which can reduce his marital satisfaction.⁴ The relationship problems associated with postpartum depression include difficulty communicating with your partner, being emotionally absent or distancing yourself from your partner, changes in intimacy, and stress from parenting. Addressing PPD is crucial in maintaining a happy relationship and the overall health of the family after childbirth; by addressing these issues linked to PPD, couples can create a nurturing environment for the newborn and improve their communication, essentially making their relationship stronger. Early intervention and support can help prevent long-term damage to relationships.⁴

Symptoms of postpartum depression

• Feeling depressed, sad, and in a low mood
• Severe mood swings
• Lack of energy and feeling fatigued constantly
• Withdrawing from social life and contact with family, friends, and partner
• Irritability and anger
• Fear of not being a good mother
• Difficulty concentrating or making decisions
• Severe anxiety and panic attacks
• Suicidal thoughts
• Crying too much
• Frightening thoughts, such as thoughts of harming yourself or the baby
• Trouble sleeping
• Loss of interest in activities you used to enjoy
• Feelings of worthlessness, shame, and guilt
• Loss of appetite or eating more than usual
• Difficulty bonding with your baby¹

Diagnosis

To assess if you are suffering from a more severe type of depression or just the postpartum depression "baby blue", your healthcare practitioner will often have a conversation with you regarding your feelings, thoughts, and mental health. Postpartum depression is a common condition that affects most women. Therefore, you do not need to feel embarrassed about these feelings and can be honest with your healthcare practitioner. Your healthcare physician may undertake a depression screening as part of your examination, which may involve having you complete a questionnaire.²

Impact of postpartum depression on relationships and how it affects marriage 

According to one study, 40% - 67% of couples experience a significant decline in marital quality during the first year of postpartum.⁴ When considering PPD, the issue seems to be much more severe. When comparing partners of postpartum women without depression, husbands of women with postpartum depression report lower levels of marital satisfaction and lower feelings of parental competence, increased conflict in the relationship, and a sense of disconnection in the relationship or marriage.⁴

Furthermore, women who experience postpartum depression report having difficulty communicating effectively with their partners and openly talk about their problems. Couples with PPD may feel emotionally detached from one another. While the affected partner may feel helpless or uncertain and unable to support them, the affected partner may withdraw from them, feeling overwhelmed or detached.³ PPD may have an impact on marital intimacy.² Relationship pressure may result from the affected partner's decreased libido or discomfort with physical contact. The lack of intimacy could make the partner feel abandoned or irritated.

Postpartum depression has a significant impact on marriages to the extent that it has the potential to be detrimental to the dynamic of the marriage, regardless of whether it is the mother or the father who has experienced depression, and the impact of this issue should not be underestimated in the cases of fathers.⁴

About 13% of postpartum women have PPD, which can have a negative effect on both the development of the mother-infant bond and the child's growth.⁵ There is evidence that paternal depression is associated with maternal depression and that men can also experience depression following the birth of a child. Family Systems Theory states that anything that impacts one family member also has an indirect or direct impact on other family members. Therefore, the depression of one parent has a significant impact on the relationships and general health of the family, affecting all members of the family and the marriage.⁵ The postpartum experience in men is usually a nagging feeling as they wonder whether their partner is nervous, anxious, and not prepared or accustomed to being a mother. Usually, these men contact doctors and other healthcare professionals to get assistance, but they feel helpless and frustrated. Men frequently turn to the internet for knowledge in an initial effort to comprehend that the woman's behaviour has changed drastically. They claim that this is the most difficult part of their marriage. Essentially, the woman's partner is also experiencing PPD, as they both try to cope with being a parent, adjusting to the new baby, and dealing with their partner's condition. There is also a high prevalence of psychiatric problems among partners of women with PPD.⁵

Causes of postpartum depression in relationship problems 

There are usually a variety of factors that contribute to the cause of postpartum depression:

• Increased workload
• Lack of communication
• History of mental health disorders, particularly depression or anxiety in earlier life
• Genetics 
• Having no support system 
• A difficult relationship with your partner 
• Financial constraints 
• Lack of quality time
• In some cases, if the baby has special needs 
• Physical or psychological trauma, such as domestic violence²

Treatment  

Although postpartum depression can be frightening, isolating, and unpleasant, there are treatments and support available that can help and support you during this difficult period, including: 

Self-help 

Start by resting whenever you get the chance, get a good amount of sleep at night, engage in self-care practices, and implement lifestyle changes such as exercising frequently, maintaining a healthy diet, talking to your family and friends about how you're feeling and what they can do to support you, and engage in the hobbies you used to enjoy before childbirth.

Talking therapy 

A general practitioner (GP) can suggest a self-help book or refer you to a therapy programme, including cognitive behavioural therapy (CBT).

Antidepressant medication

In the case where other therapies have not been successful or if your depression is more severe, your physician can recommend a medication that is safe to take while breastfeeding.^1-2

Prevention strategies  

You can take certain preventative measures during pregnancy, such as maintaining a healthy lifestyle and establishing a support system.

It might also be beneficial to attend prenatal classes and form friendships with other pregnant women or new parents who you can share your experiences with and relate to.

Another preventative measure is to speak with your mental health team or a general practitioner if you are pregnant or considering becoming pregnant, especially if you have a history of depression or other mental health issues. This is so they can provide you with the right care if someone in your family—like your mother or sister—had mental health issues following childbirth, as genetics is one of the risk factors for postpartum depression. You can also speak with a midwife, who can assist you or, if necessary, a referral to specialised mental health services. If you experienced mental health issues during your pregnancy in the initial weeks following delivery, your doctor should make arrangements for you to have frequent check-ups. Throughout your pregnancy and after giving birth, the mental health team, maternity team, and GP will work closely with you to support you if you are experiencing PPD or help you prevent it if that is something you are worried about. 

Summary 

Postpartum depression can affect both mothers and fathers. Symptoms of PPD include mood swings, fatigue, difficulty bonding with your child, and withdrawal from your partner, family, and your social life. It is important to have early interventions in place and take preventative measures to avoid experiencing PPD, especially if you have previously suffered from any mental health disorders such as depression and anxiety. “PPD significantly affects a lot of relationships and marriages negatively due to the lack of communication, intimacy, increased conflict and arguments, which is very damaging to one’s relationship after childbirth”.